Could Alcoholics Anonymous become Irrelevant?

Case for Change at AA

TheCase for Change at AA​

​​AA has helped many thousands of people--there is absolutely no doubt. But far more people have tried it with little or no success. In addition, it is increasingly under attack, from declarations of its "irrationality" to accusations of sexual misconduct.

Unaddressed, these concerns run the risk of AA becoming irrelevant. Is it possible to improve AA so it is more effective, yet retain the essence that has helped so many? The answer is YES. Read More Below.

Alcoholics Anonymous (AA) has been getting a lot of bad press lately, from articles referring to its "irrationality" to accusations of sexual misconduct. While some of these criticisms are unfair or open to debate, it is becoming clearer that parts of the program need to be revisited, both to address real concerns as well as adjust the program to the new realities of the 21st century. Specifically, AA needs to address five key issues, including:

Uncertainty about AA’s real impact. AA’s real success rate is unclear. Some non-AA research puts success percentages only in the single digits, a rate far lower than AA claims. This debate on effectiveness has been going on for years and is increasingly undermining AA’s reputation.

Growing, personalized competition. The Handbook of Treatment Approaches ranks 12-step programs and AA as 37th and 38th respectively in effectiveness out of 48 approaches to alcoholism treatment. Most of these higher-ranking programs are tailored to the individual and sometimes combined together, whereas AA takes a one-size-fits-all, AA-is-all-you-need approach, constraining effectiveness.

AA’s oversized role in our medical and legal systems. Historically this is understandable—when AA was founded there were practically no alcoholism treatment alternatives. Yet even with today’s numerous options many rehabilitation centers still use AA as the cornerstone of treatment, while courts routinely require DUIs to attend AA meetings, regardless of a person’s specific circumstances. Throwing AA at alcohol abusers as the default treatment can be a disservice to other treatment methods, the individual and even AA itself.

Antiquated literature. AA literature sometimes comes across as stale and even sexist by today’s standards. The cornerstone of AA—the “Big Book” —was written in the late 1930s and has changed little. Its male-centric literature hardly acknowledges the existence of female alcoholics, likely alienating many, as do decades-old stories. AA also makes little use of technology, a particular disconnect for younger members and AA newcomers.

Conflicting messages about AA’s spiritual nature. AA is very God-intensive but tries to hide it in an effort to broaden its appeal. Its concept of a “Higher Power” is particularly geared towards newcomers, who can become confused when the somewhat secular approach they expect gives way to AA’s spiritual 12 Steps (five are centered on God) and literature with more than 750 references to God and other religious terms (and only 75 for Higher Power). This confusing use of spirituality can be discouraging and can undermine the powerful role God/religion can play in overcoming alcohol abuse.

How should AA respond to these concerns? AA has changed little in 8 decades, and history is littered with the graves of institutions that did not adapt to a different world. Some potential ideas for AA to consider include:

Determine AA’s true effectiveness. Commission an independent study to determine AA’s effectiveness by key dimensions (e.g. gender, age, race, economic strata, etc.), the detailed why’s and when’s of its successes and failures, and use these as a new foundation for updating the program.

Revamp the “Big Book.” Update the Big Book and associated teachings to reflect the deeper understanding of AA’s effectiveness as well as advancements in science and in social norms, particularly regarding women and younger generations—two key demographics needed to survive long-term. Leverage technology to make its teachings more useable and interactive online and in the mobile world, as well as more customizable to individual circumstances.

Emphasize AA’s spirituality. It is time to stop straddling a secular fence and describe AA for what it is—intensely spiritual. New members will know what they are getting into—increasing the likelihood of their sticking with the program. An alternative would be to increase “Higher Power” references in any update.

Integrate With Other Treatment Approaches. Move beyond the AA-is-all-you-need philosophy to integrate with other treatments, teachings, and community structures. This includes becoming more open towards utilizing AA’s greatest asset—its community meetings and network—as a tool for other programs to use, with or even without AA teachings.

These are not easy changes, particularly since AA is more an association of groups guided by common principles than a top-down hierarchy. But without change AA runs the risk of becoming marginalized in the addiction treatment world. Future alcoholism sufferers and their families will be grateful.